Successful conservative management of hepatic portal venous gas complicating severe immune-related gastrointestinal injury during pembrolizumab-based concurrent chemoradiotherapy for cervical cancer: a mechanistic case report
- 1Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui , ,
- 2Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui , ,
Abstract
Concurrent chemoradiotherapy (CCRT) combined with pembrolizumab has become the standard treatment for high-risk locally advanced cervical cancer, increasing the need for prompt recognition of immune-related adverse events (irAEs). We report a rare case of severe gastrointestinal irAE complicated by hepatic portal venous gas (HPVG) during pembrolizumab-based CCRT. A 72-year-old woman with FIGO 2018 stage IIIC1r cervical squamous cell carcinoma developed persistent diarrhea and anorexia during treatment, followed by sudden hematemesis after the first brachytherapy session. Upper gastrointestinal endoscopy revealed diffuse gastric mucosal necrosis, while contrast-enhanced computed tomography demonstrated HPVG, intramural gastric gas, and diffuse gastrointestinal wall edema without evidence of intestinal ischemia. Gastric biopsy showed marked intraepithelial lymphocytic infiltration predominantly composed of CD8-positive T cells, consistent with pembrolizumab-induced gastrointestinal irAE. High-dose corticosteroid therapy and supportive conservative management resulted in rapid clinical and radiological resolution, avoiding surgical intervention. This case highlights that gastrointestinal irAEs may mimic conventional CCRT-related toxicities, delaying diagnosis. Furthermore, HPVG should not be considered synonymous with intestinal necrosis. Careful integration of clinical, radiological, endoscopic, and pathological findings is essential to distinguish immune-mediated gastrointestinal injury from ischemic disease and to guide appropriate management.
Related
- Umbilical cord ulceration complicating fetal upper gastrointestinal obstruction: a case report.
- Probiotics and Semaglutide Therapy: Mechanistic Perspectives and Potential Interactions in Gut Microbiota, Gastrointestinal Function, and Metabolic Health
- Risk factors for plastic bronchitis complicating severe Mycoplasma pneumoniae pneumonia in children and development of a machine learning-based predictive model
- Aortopulmonary Fistula Complicating a Ruptured Infected Proximal Descending Thoracic Aortic Pseudoaneurysm.
- Lactic Acidosis and Inferior Epigastric Artery Hemorrhage Complicating Alcohol-Associated Cirrhosis and Pancreatic Diabetes: A Case Report
BibTeX
@article{minamitani2026successful,
title = {{Successful conservative management of hepatic portal venous gas complicating severe immune-related gastrointestinal injury during pembrolizumab-based concurrent chemoradiotherapy for cervical cancer: a mechanistic case report}},
author = {Miwa Minamitani and Hideaki Tsuyoshi and Tatsushi Naito and Yasunari Nakamoto and Makoto Orisaka},
journal = {Frontiers in oncology},
year = {2026},
month = sep,
doi = {10.3389/fonc.2026.1942174},
url = {https://europepmc.org/article/PMC/PMC13661450},
note = {CC BY},
}
RIS
TY - JOUR
TI - Successful conservative management of hepatic portal venous gas complicating severe immune-related gastrointestinal injury during pembrolizumab-based concurrent chemoradiotherapy for cervical cancer: a mechanistic case report
AU - Miwa Minamitani
AU - Hideaki Tsuyoshi
AU - Tatsushi Naito
AU - Yasunari Nakamoto
AU - Makoto Orisaka
PY - 2026
DA - 2026/09/30
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1942174
UR - https://europepmc.org/article/PMC/PMC13661450
AB - Concurrent chemoradiotherapy (CCRT) combined with pembrolizumab has become the standard treatment for high-risk locally advanced cervical cancer, increasing the need for prompt recognition of immune-related adverse events (irAEs). We report a rare case of severe gastrointestinal irAE complicated by hepatic portal venous gas (HPVG) during pembrolizumab-based CCRT. A 72-year-old woman with FIGO 2018 stage IIIC1r cervical squamous cell carcinoma developed persistent diarrhea and anorexia during treatment, followed by sudden hematemesis after the first brachytherapy session. Upper gastrointestinal endoscopy revealed diffuse gastric mucosal necrosis, while contrast-enhanced computed tomography demonstrated HPVG, intramural gastric gas, and diffuse gastrointestinal wall edema without evidence of intestinal ischemia. Gastric biopsy showed marked intraepithelial lymphocytic infiltration predominantly composed of CD8-positive T cells, consistent with pembrolizumab-induced gastrointestinal irAE. High-dose corticosteroid therapy and supportive conservative management resulted in rapid clinical and radiological resolution, avoiding surgical intervention. This case highlights that gastrointestinal irAEs may mimic conventional CCRT-related toxicities, delaying diagnosis. Furthermore, HPVG should not be considered synonymous with intestinal necrosis. Careful integration of clinical, radiological, endoscopic, and pathological findings is essential to distinguish immune-mediated gastrointestinal injury from ischemic disease and to guide appropriate management.
SN - 2234-943X
ER -